The United Nations' Millennium Development Goals (MDGs) are the most widely recognized and broadly endorsed framework for alleviating poverty and encouraging development. The eight MDGs outline specific goals that nations and international organizations are to achieve by 2015. Yet Return of the Population Growth Factor: Its impact upon the Millennium Development Goals, a report that grew out of hearings held by the Parliament of the United Kingdom, concludes that it will be difficult or impossible to achieve the MDGs with the current rate of population growth in the world's poorest countries. At an event hosted by the Woodrow Wilson Center's Environmental Change and Security Program on September 12, 2007, a distinguished panel of policymakers and population and family planning experts drew attention to the continued rapid population growth in the world's lowest-income countries and its implications for development, health, education, and the environment. The event was co-sponsored by the World Bank, the U.S. Agency for International Development (USAID), and Venture Strategies for Health and Development.

Increasing Populations, Increasingly Impoverished

Venture Strategies' Martha Campbell introduced and commended Richard Ottaway, a Conservative Member of Parliament in the United Kingdom, for his leadership on the issues of population growth and poverty alleviation. Ottaway, who is vice chair and inquiry chair of the All Party Parliamentary Group (APPG) on Population, Development and Reproductive Health, which authored the report, described its key findings. The report draws on oral and written testimony from more than 75 population and reproductive health experts and representatives of international development institutions. "An important point here is that it is not politicians saying what they think ought to happen—it is an evidence-based report," said Ottaway.

Ottaway also emphasized that the report was driven primarily by the concerns of developing countries themselves, not by donor countries. According to written evidence that the UN Department of Economic and Social Affairs submitted to the APPG on Population, Development and Reproductive Health in 2006, the governments of 80 percent of the world's Least Developed Countries consider their population growth too high. The fact that the MDGs do not directly address population growth is a major oversight, argued Ottaway, who believes that this lack of focus on population and family planning could sabotage efforts to achieve the MDGs.

Ottaway presented sobering evidence of the challenges that high population growth poses to each of the MDGs. For instance, one of MDG 1's specific targets is to halve the proportion of people living in extreme poverty (on less than $1 a day) by 2015. Yet between 1990 and 2001, the proportion of sub-Saharan Africans living in extreme poverty increased from 44.6 percent to 46.4 percent, and the absolute number increased from 230.7 million people to 318.4 million people.

Ottaway also noted that population growth will make MDG 7, which advocates progress on environmental sustainability, more difficult to achieve. Ninety-five percent of the world's population growth occurs in developing countries, and as these countries industrialize, their carbon emissions will also increase, expanding the global total. Moreover, in many developing countries, population growth is already exacerbating negative environmental trends such as deforestation, land degradation, water scarcity, and fisheries depletion. Ottaway emphasized, however, that developed country consumption—rather than developing country population growth—is overwhelmingly responsible for current high levels of greenhouse gas emissions.

Ottaway lamented the fact that global funding for family planning declined during the decade that followed the 1994 UN International Conference on Population and Development in Cairo. "In my view, we've lost a decade. Access to family planning has stalled in many parts of the world since the early '90s. And how did this happen? Well, it became politically incorrect to talk about family planning in the 90s for a number of reasons—many political. Focus shifted from talking about big numbers to individuals. Now, there's nothing wrong with this, but it took the focus off family planning, and HIV/AIDS took over as the issue of the moment. But there is still a large unmet demand for contraception, and the poorest are those who suffer most," he said.

Ottaway emphasized that by addressing the unmet need for family planning in the developing world, donor governments, international organizations, and NGOs could significantly reduce population growth and help developing countries achieve the MDGs. "Around 30 percent of Africans want contraception but don't have access. Family planning is not expensive, and it doesn't need to be prescribed by a doctor. So we have the answer, it doesn't cost much, and its impact could be enormous," said Ottaway.

A "Job Half Done"

John Cleland, a professor of medical demography at the London School of Hygiene & Tropical Medicine, emphasized that family planning remains a "job half done." Since the mid-1990s, donor governments and international organizations have largely shifted their focus away from family planning to other public health issues. The overall rate of population growth has slowed, even in sub-Saharan Africa, but absolute numbers continue to grow—and absolute numbers have a huge impact on poverty alleviation and environmental degradation. "We must never forget that international family planning is a huge success story. The trouble is, we've forgotten about it," said Cleland, who urged the United States to again take a leading role in advocating and funding family planning programs.

Cleland reminded the audience that initial reductions in fertility do not guarantee further decreases, pointing to Kenya as an example of a country that made great strides in family planning, only to see that progress stall. From 1980 to 1995, Kenya was able to significantly reduce its total fertility rate (TFR) due to the confluence of several favorable factors and effective policies, including strong political support; effective utilization of mass media; broad access to family planning methods through health facilities, community distribution, and social marketing; and ample international funding. Cleland believes this was a "reproductive revolution that…could happen all over Africa, given political will."

Yet around 1995, contraceptive use in Kenya leveled off, and TFR stagnated and even began to rise slowly. Although a slight rise in fertility does not sound catastrophic, this small increase caused the UN to nearly double its 2050 population estimate for Kenya, from 44 million people to 83 million people. "These small plateaus—a delay in the decline—carry huge long-term implications," said Cleland. He believes that donor countries and international organizations bear much of the blame for Kenya's fertility stall, as well as for a lack of family planning progress in other developing countries. The vast majority of developing nations have appropriate population and family planning policies, said Cleland, but they have received far too little encouragement and financial support from donor nations to be able to fully implement them.

Cleland believes that family planning will again become a global priority when the population community makes the case to donors that it is an effective poverty alleviation strategy. "We've got to re-forge the link between family planning investment and poverty reduction…that was broken, largely at Cairo," he said. "Nearly half of those 76 poorest countries in the world have population growth sufficiently high to jeopardize the MDGs and at the same time, a high level of unmet need. It's a vivid demonstration to me that the humanitarian case for investment in family planning and the economic case go hand in hand—they don't pull in different directions."

Unmet Need: Obstacles and Opportunities

There is still massive unmet need for family planning methods in the developing world, said Ndola Prata of the University of California, Berkeley. Many factors contribute to the persistence of this unmet need, including lack of access and availability; poor quality of services; limited contraceptive choices; lack of knowledge and misinformation; and social and cultural opposition. Yet, according to Prata, providing more accurate and complete information on contraceptive methods; allowing birth control pills to be obtained without a prescription; making prices affordable for all segments of society; and establishing creative delivery systems for family planning services could all help reduce this unmet need for family planning in developing countries.

Reconciliation and Revived Efforts

Steven Sinding of the Guttmacher Institute argued that the international climate for family planning, although still somewhat chilly, has shown encouraging signs of thawing over the past year, including at key institutions such as the World Bank. Return of the Population Growth Factor "is among the earlier in what is looking like a series of interesting pieces that are beginning to remind the world that this is unfinished business," he said.

Sinding urged the reproductive health community and the population community to move beyond the bitter aftermath of the 1994 Cairo conference, arguing for accommodation on both sides: "It is critically important, in my view, that renewed interest in population not reopen the ruinously destructive pre-Cairo battles between reproductive health advocates and the population community." Reproductive health advocates, he said, should recognize that in some countries, high fertility is a serious obstacle to achieving the MDGs, while the population community must agree to demand that governments adhere rigorously to non-coercive methods.

Like Cleland, Sinding said that the United States should again take a leadership role in funding family planning programs. He also implored the World Bank to develop an internal consensus on these issues so that it could once again become the leader on population and family planning issues that it was during the 1960s and 1970s. "The Bank has access, it has credibility, it has a dialogue on macro issues that puts it in a unique position among external actors to discuss intelligently, dispassionately, and from a development perspective why family planning and population ought to remain high—or ought to be high—on the agendas of African states," he said.

Following a lively and frank discussion, Malcolm Potts of the University of California, Berkeley offered his own assessment of the state of family planning since the 1994 Cairo conference: "I think in 1994, many international organizations and donors misinterpreted the very laudable long-term goals of the Cairo conference as an invitation to launch a range of pilot projects in sexual and reproductive health. They lost their focus on the one thing which we know how to do, which is how to give women choices in family planning on a very large scale—and men also….Family planning in many parts of the world has been a huge success. We want to extend that success to other areas."

Like Sinding, Potts emphasized that the reproductive health field's focus on individuals' rights and choices and the population field's focus on broader trends and numbers are both essential perspectives. "We all are deeply interested in the welfare of individuals, and also aware and have a sense of scale about what rapid population growth means….All of us, I think, are sincerely and passionately committed to the human rights aspect of this, but we also ask our friends who have come from that perspective to recognize that numbers are also very, very important," said Potts.

Rapid population growth's negative impacts on areas such as economic development and human and environmental health also pose troubling security implications, warned Potts. "In 2050, there will be 10 million largely unemployed, angry young men age 15-24 [in Afghanistan]—a potential source of warriors and terrorists. The 19 men who attacked America six years ago yesterday all grew up in countries with rapid population growth and economies unable to provide dignified employment to young men—something which the 9/11 Commission rightly called ‘a recipe for terrorism,'" said Potts. He called family planning a modern-day philosopher's stone, arguing that it "transmutes the slavery and dangers of coercive childbirth into healthy families. It bestows autonomy on women, increases economic opportunities, and has the potential to make a violent world a little bit more peaceful."

Drafted by Rachel Weisshaar.